Application of posterior approach in retroperitoneoscopic adrenalectomy in the treatment of adrenal tumors

Abstract

Objective To investigate the feasibility and efficacy of posterior retroperitoneoscopic adrenalectomy (PRA). Methods From September 2013 to September 2015, the clinical data of 35 patients who underwent posterior retroperitoneoscopic adrenalectomy were reviewed. There were 14 males and 21 females, aged 15-70 years, with the average of 45.8 years. Preoperative CT scan showed 19 adrenal tumors in the left side, 16 in the right side, and one case with the left adrenal adenoma combining with right renal cyst. Tumor diameter is between 10~60mm, with the average of 31mm.Twenty-two cases were diagnosed as primary aldosteronism, 4 pheochromocytoma, and 9 non-functional adrenal tumor. The posterior retroperitoneoscopic adrenalectomy were performed in all of the cases, which are under general anesthesia with tracheal intubation and prone position with hip joints and knee joints flexion of 90. Results Thirty-five operations were successfully completed via the posterior approach demonstrating clear anatomical layers. The operation time was 38-138min(mean 70 min), the drainage tube indwelling duration was 1-5d(average 2d), and the hospital stay was 2-6d(average 4d). Total costs of hospitalization were 14 789-31 992 yuan RMB, with an average of 21 239 yuan RMB. No complications occurred during the perioperative period. The average follow-up was 11 months, and no complications such as tumor recurrence occured. Conclusions Retroperitoneoscopic adrenalectomy provided clear anatomical views. It could be a safe and effective operation for the treatment of adrenal tumors. Key words: Prone position; Adrenalgland neoplasms; Posterior approach